by Barbara Ebel
The expressions from the audience wore worried looks. Dr. Harvey stood at attention to the side of the stage. She took a step and demonstrated her next slide.
“Yes, appalling, isn’t it? Does this mean we are training bad doctors? Does this mean physicians in university teaching situations and those out in private practice are inherently bad?”
Some folks squirmed in their seats. “No,” she said, answering her own question. “The researchers say that most errors are represented by systemic problems. Health care workers may poorly coordinate the care of patients; hospitals, other health care facilities, and doctor’s offices may lack or underuse safety protocols; there may be physician practice patterns which lack accountability; and insurance networks may be broken down.
“I wonder if medical errors are even underreported because there is always the fear that if a physician or other health care provider reports an error, they will be punished or they will be incriminated by the legal system. As you all are aware, in our training programs, those repercussions are dampened because of the systems we have in place. We should all report errors when we learn about them so that the problems involved can be addressed, allowing us to change some medical schematic that is in need of repair.”
Bob nodded in the front row and she glanced quickly at Roosevelt.
“Here are some tips about giving a medication to a patient. Some of us personally deliver drugs more than others, such as anesthesiologists; in other cases, the nursing staff is carrying out doctors’ orders.. Remember all the ‘R’ tips.” She turned to a slide with a list of eight bullet points:
“Right medicine
Right dose
Right patient
Right time
Right route
Right documentation
Right reason
Right response.”
She paused, giving everyone a chance to read. “Remembering and abiding by these may prevent a medical error. They are self-explanatory, such as … is the right medicine being given or is the medicine you’re about to give going to the right patient? What about the correct route? Are you sure whether or not the drug is to be given by mouth, through a vein, or an intramuscular shot? Is the patient exhibiting the correct response from the drug you just gave?
“This last week, a patient died on the obstetrics ward because the correct drug was given but in an accelerated intravenous time frame because of a mix-up when the medication label was incorrectly slapped on the wrong IV bag. In essence, the simple Lactated Ringer’s IV solution without the label was the bag that had the magnesium sulfate in it and ran into the patient’s vein at a higher rate meant for hydration … causing an overdose.”
There was so much more she could tell to all the concerned faces in front of her. “Another thing … we had a patient on the ward mistakenly receive morphine instead of Motrin. Sometimes caregivers have difficulty reading physician’s handwriting. If an order is handwritten, it must be legible!”
Next, Annabel highlighted drugs that sound alike when an order is verbally given, cautioning physicians to pronounce them clearly. When she looked over at Dr. Harvey, he pointed to his wrist watch. She looked at the wall clock.
“It’s time to wrap this up,” she said. “Although we’ve only touched on these three topics, I hope they leave you with a lasting impression and you will take care to practice the advice or look into these matters further. Dr. Harvey wants me to remind you to attend the next M&M conference.”
Roosevelt began clapping as he strolled over and the audience gave her a loud applause, which was more emphatic than most endings to grand rounds.
“Thank you, Dr. Tilson,” Roosevelt said. “We appreciated your fine presentation and important topics.”
Annabel nodded and put the remote on the podium.
“Are there any questions?” he asked.
No one raised their hand and yet no one seemed to be in a hurry to leave.
“Thanks, Annabel,” someone finally said.
“I second that,” Bob said from the front seat.
-----
The technician helping with grand rounds stepped over from the sidelines, pulled out Annabel’s flash drive, and packed up the wires. Many attendees came forward and complimented Annabel, and soon the majority of people thinned out of the auditorium.
“Nice work,” Dr. Harvey said. “You did an excellent job. The residents, students, and staff in this room will especially remember this talk because it was given by you … an example of a doctor-in-training who is and will be making a difference in health care.”
He nodded as she slipped the flash drive in her pocket. All of a sudden, every last morsel of nervousness from before the lecture lifted like a bird in flight and tiredness swept over her. She arched up her eyebrows, trying to fight the feeling.
“Thank you, Dr. Harvey.”
“I think you have some sleep to catch up on. You call me late in the afternoon if you don’t nap. If that is the case, I’ll arrange for you come in later, around 9 p.m., for overnight call.”
She took comfort in his words and thoughtfulness. “I don’t know what to say.”
“You’re welcome.” He left in a hurry, ready to face the responsibilities of the obstetric ward.
Annabel walked down the short staircase where Bob waited for her.
“You hit that lecture out of the ball field!”
She rolled her eyes. “You’re just saying that.”
“Really. You didn’t bore us with jammed up slides with too much to read like some lecturers do. You were succinct and interesting and educational. Shall I go on?”
“No, but Dr. Fleming and Dr. Harvey did render their help.”
“Yes, I’m sure. But you pulled it together and stood on that stage like a champ.”
“All right already. That’s enough.”
“I’m finished, but I’m so sorry again about Oliver. We have to do something about his behavior. You can’t not sleep like that.”
“Neither can you. Your time will come. I’ll ask the vet and search online about dogs with storm phobias. Poor Oliver. He doesn’t intend to be so frightened. It must be in his genes.”
“Speaking of genes, Oliver’s DNA results arrived in an email. But, come on, I need to hustle back to the internal medicine ward. The student who was with me already left. And you … you must go home and get some sleep and be sure not to tank down coffee from the Keurig machine I gave you.”
“His DNA results are back?”
Bob nodded with a mischievous smile.
“Bob Palmer, do I have to squeeze the report out of you? Let’s hear it.”
They both walked out the back door with their shoulders close together, talking about Oliver the whole way.
END
DANGEROUS DOCTOR: Book Six
The Dr. Annabel Tilson Novels
Barbara Ebel, M.D.
Dangerous Doctor Copyright © 2019 by Barbara Ebel, M.D.
http://barbaraebel.weebly.com
If you’d like a release alert for when Barbara Ebel has new books available, sign up here. This is intended only to let you know about new releases as soon as they are out.
License Notes
All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means – whether auditory, graphic, mechanical, or electronic – without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.
Paperback ISBN-13: 978-1-7324466-4-9
eBook ISBN-13: 978-1-7324466-3-2
This book is a work of fiction. Names, characters, places and events are the product of the author’s imagination or are used fictitiously. Any resemblance to actual events, persons, or locations is coincidental.
*****
CHAPTER 1
The thickset man stood with a girth as solid as a tree trunk, his eyes peering at a patient’s
chart from underneath bushy eyebrows. He stood barely at five-foot-six inches and his firm abdomen protruded from the middle of his white coat, enough to mimic a woman’s early pregnancy. His name was George Gillespie, or more formerly noted on his desk placard as “Dr. George Gillespie, Pediatrician.”
Medical student Annabel Tilson had no clue what the attending doctor was reading from inside the folder he held in his stubby fingers. It was not yet noon and she had tailgated him all morning in his private practice, which he shared with one other physician. Now, as well as earlier, the man’s facial expression was full of prim self-restraint.
He wore a thin black mustache; one so inconspicuous that she wondered why he bothered to let it grow at all. Below it, his lips failed to crack a smile. Nor did he verbally share an observation with her about what he surmised from the preliminary information noted in the chart about the patient’s visit. He closed the file, gave a knuckle tap on the door, and turned the doorknob. With a slight nod of his head, he motioned for her to follow him into the room.
Sitting in a chair, a woman straightened her shoulders and squared her glasses on her nose. Her son, Toby, swung his legs from the examination table and flinched as Dr. Gillespie took two steps forward. The eleven-year-old extended his arms behind him and leaned back like he was giving himself space to evaluate George’s approach.
Annabel remembered being the young boy’s age and a pediatrician’s office was the last place the red-headed youngster would want to be. In the height of the summer, before school started back, there were plenty of activities he could be engaged in outside.
“Hi, Dr. Gillespie,” the woman said. “You previously told me that Toby is old enough to be seen without me, but I want to address two issues with one visit.” She stayed put, appearing comfortable in shorts and a loose white blouse, and darted her eyes to Annabel.
“Mrs. Owens,” Dr. Gillespie said, “Annabel is the newest medical student shadowing me on her pediatric rotation.”
“No problem.” She shrugged while reaching down to a single folded piece of paper lying on top of her pocketbook. Toby and Annabel cracked a smile at each other.
Dr. Gillespie took the form she handed him: “Ohio Department of Health • School and Adolescent Health • Physical Examination.” He rotated his arm to the side and handed it off to Annabel. “A back-to-school form for the nurse’s office.”
Annabel scanned the sheet, which included boxes for a physical exam, health history, screening for vision, hearing, and posture, as well as questions related to speech and ability to participate in academics and sports.
“Let’s get going, then,” George said. He asked Toby to lean forward while he peered into his ears with an otoscope.
“Dr. Gillespie always says not to wait until the last minute to bring your kid in before school starts,” Anne explained to Annabel. “Otherwise, the waiting room is so jam-packed, you’d think he and his partner were giving away free tickets to a Reds baseball game.”
Dr. Gillespie tapped his finger on Toby’s chest. The youth grasped the Florida tourist T-shirt he was wearing and swiped it over his head as if on cue. The pediatrician listened to his heart and lungs and soon asked Toby to walk back and forth in the room. He paid strict attention to his patient and then sat on a stool with the entire medical folder. Annabel handed him back the sheet.
“Does Toby wear glasses that I’m not aware of?”
“No,” Anne said.
George checked off multiple boxes for “yes” or “no” responses and collaborated with Mrs. Owens that Toby had no new physical or academic limitations.
“Tell Dr. Gillespie what you’ve been complaining about,” Mrs. Owens said to her son as she handed him back his shirt.
George glanced over at her and grinned. He hated twofers; when a patient’s office visit ended up with two chief complaints and diagnostic problems because he could only bill for one. A robust yearly salary was not what he was in the specialty for, however, it was becoming more difficult these days to make a reasonable living despite all the hours he put in.
Toby popped his head through his top and grimaced. “Mom, it’s not a problem and I’ve hardly been complaining.”
“I know you better. You don’t want to miss swimming or soccer when school starts, but you did complain twice since we came back from our Florida vacation.”
Toby rolled his eyes with emphasis. “I guess my legs are getting some muscle pain. And yesterday, it started in my back and arms.”
“On physical exam,” George said, “you’re a healthy young eleven-year-old and you’re walking fine. If you have that symptom tonight, one aspirin may chase it away.” He closed Toby’s record and stood. “I’m giving the school form to the front desk so they can make a copy. You two can pick it up on the way out.”
Annabel, Anne, and Toby followed Dr. Gillespie out the door. At the front desk, he added with a sour face, “You know where to find us, but chances are, Toby’s muscles are starting to go through a growth spurt. Before you know it, he’ll be too old to visit a pediatrician anymore.”
“Thanks, Dr. Gillespie,” Anne said, taking the original school form.
“Bye,” Annabel said. “Enjoy the remaining time you have off, Toby, before school starts.”
“Thanks. Nice meeting you.”
Mother and son disappeared out the door. For Annabel’s benefit, Dr. Gillespie muttered out loud as he wrote cursive at the bottom of Toby’s office note. “Last-minute comment after school physical: myalgias for several days.”
Annabel sighed. For her, gone were the summers spent with her family enjoying the great outdoors in Tennessee. Amazingly enough, however, this was her last real summer in medical school because this time next year, she’d be starting residency. Pediatrics was her last major subject specialty rotation and maybe it was going to be easier than she thought. She would appreciate a more relaxed atmosphere after her experiences so far.
Another medical student friend, Stuart Schneider, was shadowing the other doctor practicing in the pediatrician’s two-physician practice. She would be glad for Stuart’s comradery, she thought. Then, after the next two weeks with Dr. Gillespie, she and Stuart would finish pediatrics with a team at the University Hospital’s children’s ward.
Annabel realized the two pediatricians were very accommodating to allow medical students to learn, yet clutter up, their office, and also knew that doctors affiliated with teaching through the medical school or residency were skilled physicians on top of their specialties. In her educational experience, most of them had big hearts to pass on their knowledge and instruct the upcoming new generation of physicians, and the ones not working full time for the University did so for little pay or secondary gain.
She eyed George Gillespie. Annabel had no opinion yet; she couldn’t discern what to make of the little sturdy physician who didn’t talk a lot.
-----
Behind the spacious front desk area, a thin wall separated one room into two. An economical kitchenette was to the right. The room adjacent to it functioned as a supply room with a compact old-fashioned Xerox machine, a stuffed bookshelf, and a card table. Stuart dawdled in there, his hands jammed in his student white jacket. The pediatrician he was following, Heather Clark, had her head posed over a pediatric manual.
Annabel and Stuart nodded at each other like some secret code to express their feeling of ineptness. At least on the internal medicine rotation they had shared, they felt needed, if not abused with “busy” work when more significant events were not keeping them occupied. They recently did OB/GYN at the same time too, but they were on opposite daily time slots.
“Annabel,” Dr. Gillespie said, “come see one more patient with me and then you two can go to lunch.”
She marched after him and he pulled another folder from the inbox outside an exam room. Inside, a young girl stood next to her mother, who sat on the chair. The six-year-old first exchanged a weary glance at Dr. Gillespie and then rested her hand on her mother’s shou
lder.
“Good morning,” Dr. Gillespie said. “Jump up on the exam table, Kellie.”
“She’s not jumping anywhere lately,” Mrs. Hill said. “She gets tuckered out quicker these days compared to her friends. We need a refill of her albuterol inhaler.”
Kellie withdrew her hand and did as she was asked. The paper on the exam table rustled as she shimmied up and got comfortable. She had thin, dry hair neatly pulled back in a ponytail and her fingernails were painted a bold pink.
George licked his finger and flipped a few pages to check the patient’s medication and prescription history. “Appears like you’re going through your inhaler quickly. Tell me in your own words, Kellie, what’s going on with your asthma.”
Dr. Gillespie slid the chart on the counter and rubbed his right thumb along the tips of his fingers. Annabel kept a low profile behind him, especially since no one had mentioned her presence.
Kellie shrugged her shoulders. “I use the inhaler almost every other day because I’m coughing. Sometimes I wake up in the middle of the night too.”
“I heard her coughing last night and made her use it,” her mother interjected.
“I bet you’re a pro at this,” the pediatrician said, standing squarely in front of Kellie, “but are you using it correctly?”
The young girl nodded. “I breathe deep and spray with my mouth around it tight. I count to ten holding my breath, take it away, and breathe out slowly.”
“She is a pro,” Mrs. Hill added and George bobbed his head in agreement.
Annabel shifted her weight from one foot to another as an overwhelming sense of déjà vu came over her. The discomfort continued as Dr. Gillespie asked his patient more questions and then examined her. When he was almost finished, Kellie had a coughing spell and took the almost-empty inhaler from her mother. She held it steady in her hand, ready to use it.
